Print
Skip left navigation

Pharmacy Resources and Physician Administered Drugs

Find pharmacy information related to prescription drugs including prescription drug lists, step therapy, quantity limits and prior authorization requirements for Community Plan care providers.  

Prior Authorization Information for Your Patient’s Medicaid Pharmacy Benefit

UnitedHealthcare Community Plan Quantity Limit Policy

UnitedHealthcare Community Plans may have monthly quantity limitations on certain medications. Prescriptions for quantities greater than the indicated monthly limits will require prior authorization. Quantity limits exist to promote efficient medication dosing and safe dosing administration.

Quantity limits also apply to certain classes of medications. Patients have access to any FOUR medications from the following classes in a 30-day period: opiate analgesics, benzodiazepines, sedative hypnotic agents, barbiturates, and select muscle relaxants. Additional fills will require prior authorization. Medications in these classes may also be subject to individual quantity limits.

Additions to the Quantity Limit (QL) program drug list will be made from time to time and providers notified accordingly. As always, we recognize that a number of patient-specific variables must be taken into consideration when drug therapy is prescribed and therefore overrides will be available through the prior authorization (PA) process.

In response to the U.S. opioid epidemic, UnitedHealthcare has developed programs to help our members receive the care and treatment they need safely and effectively.

We’ve also established measures based on the Centers for Disease Control and Prevention’s (CDC) opioid treatment guidelines to help prevent overuse of short-acting and long-acting opioid medications.

Resources from UnitedHealthcare and Optum

Other Resources

Streamline Your Prior Authorization Process with CoverMyMeds

CoverMyMeds streamlines the medication prior authorization process, electronically connecting providers, pharmacists and plan/PBMs to improve time to therapy and decrease prescription abandonment with electronic prior authorization.

Get Real-Time Prescription Costs and Coverage Details

The PreCheck MyScript Solution on Link helps make it easy to run a pharmacy trial claim and get real-time prescription coverage detail for your patients who are UnitedHealthcare benefit plan members.

Specialty pharmacy medications covered under the member’s medical benefit may be obtained through various sources ‒ home infusion providers, outpatient facilities, physicians or specialty pharmacy.

Network Specialty Pharmacy 

If you don’t want to buy and bill a specialty pharmacy medication covered under the member’s medical benefit, you may order it through the following network specialty pharmacy:

  • BriovaRx 855-427-4682

Additional Specialty Pharmacies 

The following specialty pharmacies also provide certain types of specialty medications:

  • Accredo (Nursing Services) 800-803-2523
    • Enzyme Deficiency
    • Gaucher's Disease
    • Immune Globulin
    • Pulmonary Hypertension
  • Option Care (Nursing Services) 866-827-8203
    • Enzyme Deficiency
    • Gaucher's Disease
    • Hemophilia
    • Immune Globulin
    • Makena
  • CVS Caremark Specialty Pharmacy 800-237-2767
    • Pulmonary Hypertension

Coverage of a requested medication depends on the member’s benefit, and availability of a specific drug from a network specialty pharmacy may vary.

Upon request, a specialty pharmacy can deliver the medication to your office or another site such as a member’s home.

Medications obtained through a specialty pharmacy will be directly billed to the patient’s health plan. 

UnitedHealthcare Community Plan of Hawaii QUEST Integration Program

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by UnitedHealthcare Community Plan - QUEST Integration Program.

Preferred Drug List

Preferred Drug List Updates

UnitedHealthcare Dual Complete® RP (Regional PPO SNP) R3175-003 Program

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by UnitedHealthcare Dual Complete RP (Regional PPO SNP) R3175-003. 

Preferred Drug List 

Additional Pharmacy Resources